This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Thursday, 14 January 2010

Hell In Staffordshire Revisited. They are indeed blaming nurses for management failures.

I really didn't want to have to do another blog linking a Nursing Times article yet again. In my opinion they are lying shills who do not know how to find decent sources to quote in their articles. But I cannot help myself. You have to keep in mind that the woman quoted in this article (Julie Hendry) will not have any experience taking on 15 medical patients on a large ward as the only RN these days. This is a situation that would suck the caring and the empathy out of Mother Theresa. If she did understand it, she is solely working under the direction of the management twatterati. So basically, she doesn't have a clue or she is hiding it. She is scapegoating nurses just as her management overlords have instructed her to do.

It's no big secret that nurses are acquiring much in the way of trauma and psychological damage as a result of the ward conditions, and their inability to care for their patients as a result of lack of trained staff and managements refusal to address safe trained nurse to patient ratios. Ratio stats.

We know that the problems in Staffordshire with nursing care were down to trained nurse to patient ratios that wouldn't be legal in a third world country. I recently did a shift with only 2 of us for the whole ward. Management did not care about the staffing levels. One of my biggest nightmares is seeing patients developing pre renal failure etc as a result of dehydration. I am commited to seeing that patients are hydrated properly. But I didn't have a chance. There was not one second during that shift where I was able to assist someone with a drink. Not at all. And it was all down to factors that were out of my control.

Here is a comment from Nurse who actually worked there. She commented on my blog.

Anonymous said...

Nurses with 'tude?
I started to develop a bad 'tude at Shitford General. This was a mad busy surgical ward, horribly understaffed and with some very acutely ill patients.
Because of the pressure in ITU we were taking HDU patients all the time. These patients were not really stable enough to be nursed on a surgical ward having had major ops like gastrectomy and oesphegectomy.
These patients needed at least half-hourly monitoring. Some had trachys. All had multiple drains, feeding tubes, catheters, stomas and multiple IVI's and IVABx. You might have two of these HDU patients to your twelve-bedded bay.
In your bay you might also have recovering colosomy, appendectomy, amputation patients with the usual complement of diabetics and complicated medical problems.
I got an attitude all right. One day a patient newly back from theatre after having extensive bowel surgery developed obvious cardiac signs (low BP, tachycardia) and was going down the tubes fast. I bleeped the team and we swung into action.
In the midst of the emergency another patient stuck his head round the curtains and demanded I do his toe dressing RIGHT NOW. The Registrar yelled at him to get out.
We saved the post-op patient. He went to CCU and all was well. I left that shift four hours late then had two days off.
On my return the ward sister pulled me up for not doing the toe dressing, the patient had complained and had said I had a "bad attitude"
Fuck him and the selfish horse he rode in on.

Well said. HDU and ITU patients are critically ill. If a nurse is responsible for these kinds of patients she cannot see her other patients. At all. Full stop. So why was shitford hospital forcing their individual nurses to take these kinds of patients on top of 10 other patients, shift after shift, and day after day? Unless you are one of these clueless visitors to the hospital or a member of the media you, of course, understand that if you have a critically ill patient for 12 hours THEN YOU CANNOT SEE ANY OF YOUR OTHER PATIENTS FOR 12 HOURS. And here in the NHS you DO NOT get another nurse to help you care for those other 10 patients. You will have to go to the nurse's station to check orders, order equipment and get/give information about your critically ill patient. It's probably a good idea to ignore anything else but what you are doing for that critically ill patient whilst you are at the station. You do not want to get delayed getting back to him because you were talking to a relative of another, stable patient. The relatives of your other patients will, of course, accuse you of ignoring their loved ones to hide at the station. They don't understand anything.

Who wouldn't have a bad attitude when you are up to your eyeballs in life and death stuff, afraid that people you are responsible for are going to die because you can't give them the time. You are dehydrated yourself and 9 hours without a meal. Your sickest patient just got worse and you have seconds to implement the actions that you need to ensure his survival. And just at that moment in time someone gets in your face and demands that you stop what you are doing to change a toe dressing. There is not a human being alive who would not explode in that instant. Nurses handle it better than others could, and they bite their tongues more often than not.

You're welcome.

Edited to add: Don't forget to add your comments over at the nursing times as well.

21 comments:

the a&e charge nurse
said...

A new management stooge is brought in after the shocking events at Stafford, so what is the first thing she does? - starts crying (ahhh).

Ms Hendry then switches to cliche autopilot, claiming: “It’s about putting the right people in as ward leaders. If you’ve got highly visible nurse leadership at ward level – your ward sisters and matrons are on the physically wards not in meetings, being reactive, answering complaints.

So the 'visible' Matron's will abandon their meetings to show their faces on the ward for 5 minutes - sounds great, doesn't it?

Nurse Anne, if you read the full report, you'll find the nursing care at Mid Staffs is rightly criticized. However, it is clear to anyone who chooses to read the report objectively (which seems to exclude most journalists), that the source of the problems was a whole range of management failures. The sort of things that you write about in this blog. That being the case, I hope the interim director of nursing is investing as much emotional energy in reforming the Trust management as she is in choking over her videos.

Glam. I have said 1000 times over that the nursing care was horrendous. When nurses are short staffed they have to ignore call bells, leave people in their own waste, they are unable to attend to basic care, they have to peel the hand of a dying woman who wants them to stay in the room to help her pass because of what is happening with another patient.

All these things happen as a result of shortstaffing not mean nurses. So yes, the nursing care would have been horrendous.

"I hope the interim director of nursing is investing as much emotional energy in reforming the Trust management".

If Anne's blog tells us anything, it's that managers either do not understand, or more depressingly, do understand but prefer to overlook those factors which would improve standards of nursing care.

To be fair to the managers they are hamstrung by endless, centrally imposed targets.

Take the A&E target (98% of patients seen and sorted in <4hrs) - remember this standard is NOT negotiable.

Wanless tells us that more than 19 million patients (and rising) attend A&E every year - this means 18,620,000 irrespective of their individual need, or complexity (children, psychiatric patients, life threatening trauma, etc) MUST be seen and sorted in an artificially compressed time frame.

Now anybody who has worked in A&E for more than 5 minutes will tell you that this level of productivity is simply impossible 24/7 - 365 days of the year.There is not an A&E in the NHS that is not cheating in some way so as to make it APPEAR that the target is being hit.

Needless to say ward staff become hacked off when they are forced to accept patients with less and less having been done for them because A&E staff have diverted their attention to the next 3 or 4 ambulance crews waiting to hand over a fresh batch of patients.

The integrity of nursing staff has been ground down and compromised by this situation - so what can the likes of Ms Hendry say to the board when there is simply no room for manouvre?

I have heard some A&E's agonise over how long incoming patients should be kept waiting, while staff hurriedly try to package a patient that is creeping up to a 4 hour wait.After a while these pressures start to get to you and I have no confidence that the sort of 'supa-nurses' envisaged by Ms Hendry will alter this fundamental landscape.

To my mind these sorts of dilemmas encapsulate many other conflicts that play out across the NHS, both in hospital and in the community - surely if a quick fix was possible, somebody would have thought of it by now.

My guess is that the current economic climate will makes things worse rather than better - we will just have to keep tuning into Anne to see her experiences match my prediction?

A&E Charge Nurse, what you say is so true. I've worked in A&E for a couple of years, and i am so demoralised with it all. I am sick of working to meet targets, instead of working to provide patient care. The priority of the day is to get patients out, from the minute they arrive. Never mind the fact that they need care and treatment. I am sick of taking poorly patients to the ward with their treatment half started/finished. I am sick of having my workload directed by the clock instead of patients needs. I am sick of putting pressure on my nursing colleagues on the wards. But I don't know what else to do, because.....you only have to read this blog to realise that the pressures on the wards are even worse. I only ever wanted to care for people. But the NHS won't let me :(

its like A/E has turned into a glorified traige station. When i used to work in A/E in london........regular tramps used to come in and when we were quiet we used to give them a bath and de-louse them. UGH the socks i used to pull off......once a large bit of dead diabetic foot came off as well. patients used to spend the night on trolleys........which was most uncomfortable for them and the kitchen used to send up sandwiches but never enough. There used to be some lovely smell..............i particullarly liked Kaolin poltice smell and also Friars Balsum. as Surgical spirit. The ECG machine was a night mare: all these little red rubber suction balls that kept popping off. Also we used to squeeze loads of sodium Bicarbonate into people during cardiac arrests. Overdoses used to have their stomachs "pumped" i remember lots of long bits of tubing and a sort of funnel thing. it was quite a deterrant for those people who keep comming back! After a busy night shift, we used to go out to a posh hotel for a fatboy breakfast. It was good. the IRA bombing was at its height and it was stressful.

Oh, we still get our regular 'gentleman of the road', Capgrass, although stomach wash outs are virtually a thing of the past I'm glad to say.

I understand reception staff at Stafford provided a sort of triage (rather like the system in the 80's) which consisted of comments like; "oi nurse, this one is still bleeding", or;"why is that old man clutching his chest and turning a funny colour, nursey".

North of the river breakfast was sometimes held at Smithfield meat market (after the last night).I stopped going after experiencing near hallucinations following a rather heavy session, what a lightweight, eh?

Capgrass wrote: "Overdoses used to have their stomachs "pumped" i remember lots of long bits of tubing and a sort of funnel thing. it was quite a deterrant for those people who keep comming back!"

Yes, I remember them too. And let's not forget that the actual stomach tubes came in a range of sizes so that the really undeserving overdoses could be made to suffer properly. But Capgrass, do you have evidence that being cruel to people who OD discourages them from having another go? If not then we must conclude that some nurses, at least, are capable of sadistic behaviour towards their patients. Which means that when nursing care is poor all possible reasons for it should be investigated including deliberate cruelty.

mea culpa glamorgist: I agree that quote "those who have the potential to do the most good are also capable of the most harm". I also agree that i have NO evidence to say that stomach pumping was a deterent. Once I washed someone out and he returned 4 hours later having done the VERY SAME THING and every time we "pumped him" he thanked us profussely. he was a simple mild soul........but obviously distressed by the voices in his head. Mea Culpa........i am glad we dont do that nasty treatment no more. Although sometimes i hate to think of all those dangerous pills lying in the stomach and wish we could just get them out rather than just processing the paperwork, waiting for a porter.......wasting time handing over to the CAU nurse and wondering how many hours the patient will wait till she has time to get some more parvolax from pharmacy, find the i.v. guidelines book, and start the bloody treatment!!!!

In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.